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covid_19_telehealth_updatesCOVID-19 Telehealth UpdatesLatest_NewsShared_Content/News/Membership_Memo/20200528/covid_19_telehealth_updates<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/May/Doc-computer-stethoscope-645x425px.jpg" class="pull-right" alt="Doctor working at computer" /> </div> <h5>May 28, 2020</h5> <h2>COVID-19 Telehealth Updates</h2> <p>A look at (and links to) current telemedicine payment parity policies, including a new extension from the Office of the Insurance Commissioner; new CMS telephone-only payments for behavioral health services; a new WSMA webinar; and more.</p> <h3>Payment parity roundup</h3> <p>During the pandemic, telemedicine has emerged as a vital resource for patients to safely access care and for physicians and practices to bring in needed revenue. To support the ongoing utilization of telemedicine, the WSMA continues to prioritize telemedicine payment parity in its advocacy at the state and federal levels.</p> <p>The following health plans and payers have passed temporary policies to pay at parity for telemedicine, including services delivered through telephone only:</p> <ul> <li><a href="https://www.insurance.wa.gov/sites/default/files/documents/emergency-order-20-02_3.pdf?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=">OIC fully insured plans</a> (the OIC has <a href="https://www.insurance.wa.gov/sites/default/files/documents/emergency-order-20-02-extension.pdf?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=">extended its emergency order</a> to health insurers expanding telehealth and other coverages until June 21)</li> <li><a href="https://www.hca.wa.gov/assets/billers-and-providers/Clinical-policy-and-billing-for-COVID-19-FAQ.pdf" target="_blank">HCA Medicaid plans</a></li> <li><a href="https://www.hca.wa.gov/information-about-novel-coronavirus-covid-19">HCA UMP (PEBB/SEBB) plans</a></li> <li><a href="https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf" target="_blank">CMS Medicare</a></li> </ul> <p>Plans not required to pay at parity - </p> <ul> <li>Certain self-insured/ERISA plans that cannot be regulated by the state. The WSMA is supporting legislation introduced by Rep. Kim Schrier (D-08) that would ensure telemedicine payment parity for ERISA plans. <a href="https://takeaction.wsma.org/tell-congress-to-prioritize-patients-and-physicians/">Write your congressional representative and urge their support for H.R. 6644</a>.</li> </ul> <h3>CMS broadens telephone-only list of services paid for by Medicare</h3> <p>CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone and now they are broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. CMS is crosswalking CPT codes 99212, 99213, and 99214 to 99441, 99442, and 99443. This will increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.</p> <h3>New WSMA telehealth webinar, more resources</h3> <p>Be sure to join us on Friday, June 19, from noon - 1 p.m., for a free webinar, <a href="[@]WSMA/Education/Upcoming_Webinars/WSMA/Education/Upcoming_Webinars/Upcoming_Webinars.aspx?hkey=b760d6bd-1833-412d-b681-babf251792a8">Telehealth: The Rapid Evolution to Full-Scale Implementation</a>, and learn how to implement a lasting telehealth program in your clinic. And be sure to visit our <a href="[@]WSMA/Resources/COVID-19_Response/WSMA/Resources/COVID-19/COVID-19_Response.aspx?hkey=958ce791-54b8-4eba-892f-54924db26b60">COVID-19 resource pages</a> for a wealth of practice guidance on telehealth, including step-by-step guidance on setting up telemedicine at your practice, information on reimbursement policies, what you need to know about HIPAA compliance during the public health emergency, federal changes on prescribing controlled substances via telemedicine, and much more.</p> </div>5/28/2020 12:00:00 AM1/1/0001 12:00:00 AM
wsma_focus_remains_on_physician_practices_as_health_care_restartsWSMA Focus Remains on Physician Practices as Health Care 'Restarts'Latest_NewsShared_Content/News/Membership_Memo/20200528/wsma_focus_remains_on_physician_practices_as_health_care_restarts<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/May/Exam-Room-645x425px.jpg" class="pull-right" alt="Exam room" /> </div> <h5>May 28, 2020</h5> <h2>WSMA Focus Remains on Physician Practices as Health Care 'Restarts'</h2> <p>WSMA CEO Jennifer Hanscom sat down with AMA Senior News Writer Sara Berg to <a href="https://www.ama-assn.org/practice-management/sustainability/hit-first-us-covid-19-washington-doctors-eye-safe-reopening">discuss the WSMA's recent work on behalf of physicians and practices</a> in response to COVID-19, including working with the state to build a framework for reopening health care and efforts to help physician practices survive the economic fallout from the pandemic. As Jennifer notes, "We are trying to educate policy makers in our state right now to do all that we can to support physician practices economically so that should the surge come back in the fall, we do have physician practices that are ready to treat those patients." Read on to get up to speed on WSMA's work on behalf of physicians and to get the latest on the state's emergency response.</p> <h3>WSMA practice guidance for resuming elective procedures</h3> <p>Gov. Inslee's <a href="[@]Shared_Content/News/Latest_News/2020/May/governor_issues_new_proclamation_on_non_urgent_procedures">latest proclamation related to health care services</a> in Washington state permits all health care facilities, practices, and practitioners acting in good faith, and that meet certain criteria, to resume providing elective procedures and other non-urgent care. The proclamation, effective May 17, is intended to remain in effect through the end of the state of emergency, and details criteria required for resuming non-urgent procedures before there is a vaccine, effective treatment, or herd immunity to COVID-19. Those criteria include monitoring resources (ventilators, beds, PPE, etc.), conserving PPE, and on-site fever screening and symptom screening for all patients, visitors, and staff, and more.</p> <p>In case you missed it: The WSMA has collaborated with the Washington State Medical Group Management Association to offer new guidance on the proclamation for medical practices. <a href="javascript://[Uploaded files/Resources/COVID19/2020.05.29-Proclamation_Guidance_for_Medical_Practices.pdf]">Download this new resource</a>. If you have questions on this new WSMA resource or what the proclamation means for you and your practice, contact the WSMA policy department at <a href="mailto:policy@wsma.org">policy@wsma.org</a>.</p> <h3>WSMA asks Legislature to support key priorities in advance of next session</h3> <p>The Washington State Legislature has established a bipartisan Special Committee on Economic Recovery that is tasked with making recommendations on COVID-19 recovery legislation in advance of the 2021 legislative session (or before then if lawmakers are called back into session this year). In anticipation of the committee's first meeting in June, the WSMA submitted a letter to all state legislators detailing key policy priorities for physician practices that would help ensure they can keep their doors open and continue to treat patients.</p> <p>Our members have identified four key priorities for the state legislature to support:</p> <ul> <li>Full resumption of medically necessary medical physician services.</li> <li>Continuation of telemedicine payment parity.</li> <li>Establishment of an enhanced Medicaid payment program.</li> <li>Tax relief.</li> </ul> <p>For details on each of these policy priorities, <a href="javascript://[Uploaded files/Resources/COVID19/5.14.20_WSMA_letter_to_the_Legislature.pdf]">download the letter</a>, delivered May 14, 2020. In our continued advocacy on behalf of physicians and practices, our core message remains the same: Just as policymakers relied upon the physician community in the state's response to the pandemic, both to treat patients and to follow state care restrictions to help flatten the curve, the physician community is now looking to policymakers to help ensure they can keep their doors open and continue to treat patients.</p> <p>While not yet official, it remains likely that a special legislative session will be needed between now and Jan. 2021 to provide additional financial resources and address needed changes to policy issues in response to COVID-19.</p> <h3>Take action: Tell Congress to prioritize patients and physicians</h3> <p>Congressional action is needed on three issues that are critically important for ensuring patient access to care and physician practice viability during the COVID-19 pandemic: 1). Requiring ERISA plans to pay at parity for telemedicine services; 2.) Enacting liability protections for health care workers as part of the next stimulus package; and 3.) Prioritizing direct support to physician practices in the next stimulus package. Elected officials in the U.S. Senate and House of Representatives need to hear from their physician and PA constituents on these issues. <a href="https://takeaction.wsma.org/tell-congress-to-prioritize-patients-and-physicians/">Learn more about these issues and send a message to your congressional representatives today</a>.</p> <h3>Legislature extends emergency proclamations</h3> <p>The <a href="https://www.governor.wa.gov/office-governor/official-actions/proclamations">emergency proclamations</a> issued by Gov. Jay Inslee in response to the COVID-19 pandemic expire after 30 days unless an extension is granted by the state Legislature. The following proclamations have been granted temporary extensions, and the WSMA continues to advocate for these policies to be extended beyond their current expiration dates as the physician community and the state respond to the COVID-19 pandemic.</p> <p>Extension approved until May 31:</p> <ul> <li><a href="https://www.governor.wa.gov/sites/default/files/proclamations/20-29%20Coronovirus%20OIC%20%28tmp%29.pdf?utm_medium=email&utm_source=govdelivery">Proclamation 20-29</a>, concerning telemedicine payment parity.</li> <li><a href="https://www.governor.wa.gov/sites/default/files/proclamations/20-32%20-%20COVID-19%20DOH%20Healthcare%20Worker%20Licensing%20%28tmp%29.pdf" target="_blank">Proclamation 20-32</a>, concerning health care worker licensing requirements.</li> <li><a href="https://www.governor.wa.gov/sites/default/files/proclamations/20-27%20-%20COVID-19%20Notary%20%28tmp%29.pdf" target="_blank">Proclamation 20-27</a>, concerning electronic notary.</li> </ul> <p>Extension approved until July 8:</p> <ul> <li><a href="https://www.governor.wa.gov/sites/default/files/proclamations/20-36%20-%20COVID-19%20-%20DOH%20Health%20Care%20Facilities-Hand%20Sanitizer%20%28tmp%29.pdf" target="_blank">Proclamation 20-36</a>, concerning the Certificate of Need program.</li> </ul> </div>5/28/2020 12:00:00 AM1/1/0001 12:00:00 AM
weekly_rounds_may_22_2020_five_things_to_know_while_staying_home_for_memorial_dayWeekly Rounds: May 22, 2020 - Five Things to Know While Staying Home for Memorial DayLatest_NewsShared_Content/News/Weekly_Rounds/2020/weekly_rounds_may_22_2020_five_things_to_know_while_staying_home_for_memorial_day<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="Weekly Rounds logo" class="pull-right" src="/images/Logos/Weekly-Rounds-Article-Graphic-645x425px.jpg" /></div> <h5>May 22, 2020</h5> <h2> Five Things to Know While Staying Home for Memorial Day </h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> While there continues to be a lot of activity at the state and federal levels in response to COVID-19, it feels to me as though we're shifting from the urgent onset reactive phase into a more intentional and thoughtful phase. </p> <p> We know we're in this for the long haul, and along with our COVID response, your WSMA team continues to advocate on the things that impact your ability to practice in today's challenging times. Hopefully you've benefitted from our intensive communications efforts as we work to bring you the latest information in nearly real time across all of our channels, including our social media feeds, our website, our biweekly e-newsletter Membership Memo, and, of course, Weekly Rounds, my personal missive to you. </p> <p> As we ready ourselves for a well-deserved long Memorial Day weekend, I offer a few brief updates you'll want to know about. </p> <h3>Deciding to meet virtually for the WSMA House of Delegates</h3> <p> At its lengthy Zoom meeting last Sunday, the WSMA board of trustees made the difficult decision to transition our usual in-person Annual Meeting in Spokane to a virtual one-day House of Delegates meeting on Saturday, Sept. 26. Out of an abundance of caution for the health and well-being of all concerned, they directed that the meeting be condensed to focus solely on the business of the House of Delegates. </p> <p> In the weeks preceding the meeting, we will open our online reference committee forums in order to give all members an opportunity to provide feedback on resolutions. In addition, we will hold virtual reference committee meetings so that members will have an opportunity to provide verbal testimony. On Sept. 26, the House will act on the reports of the reference committees, vote on the slate of candidates for the board of trustees, and conduct other business of the House. Your WSMA staff is currently working on the new schedule and will share more information soon. </p> <h3>Taking action to say "no" to psychologists' scope expansion</h3> <p> The Washington State Department of Health will hold a sunrise review hearing on psychologists' prescriptive authority. The WSMA opposes efforts to expand non-physician practitioners' prescriptive authority and any scope of practice increase that does not stipulate commensurate education and training to what a physician receives, and thus we oppose this expansion. </p> <p> By way of some background, late in the 2020 legislative session, <a href="https://www.doh.wa.gov/Portals/1/Documents/2000/HB2967.pdf" target="_blank">House Bill 2967</a> was introduced to grant psychologists prescriptive authority. While this bill was not considered during session (i.e. no public hearings were held), it served as the catalyst for this sunrise review. Sunrise reviews are the process by which the DOH considers proposals that would amend practices of regulated health professions in the state. </p> <p> <a href="https://www.doh.wa.gov/Portals/1/Documents/2000/SunriseRequest.pdf" target="_blank">Requested by the Legislature</a>, DOH will now review the <a href="https://www.doh.wa.gov/Portals/1/Documents/2000/2020-Sunrise-PsyScope.pdf" target="_blank">proposal submitted by the Washington State Psychological Association</a> and provide opportunities for stakeholders to engage and provide comments as the department drafts its report. At the end of the review process, DOH will issue a final report with their recommendations to the Legislature. While these recommendations are technically advisory, they often serve as the basis for future legislation. </p> <p> Comments on the initial proposal are due by June 17 at midnight and should be emailed to <a href="mailto:sunrise@doh.wa.gov">sunrise@doh.wa.gov</a>. Once the WSMA has compiled our draft comment we will share it with you. In the meantime, should you have any questions, concerns, or feedback, or if the WSMA can be helpful to your organization on this issue, email Alex Wehinger, WSMA's associate director of legislative and political affairs, at <a href="mailto:alex@wsma.org">alex@wsma.org</a>. </p> <h3>Reporting out to improve opioid prescribing practices</h3> <p> The latest round of the Washington Opioid Reports, the key feature of our <a href="[@]WSMA/Resources/Opioids/Better_Prescribing_Better_Treatment/WSMA/Resources/Opioids/Better_Prescribing_Better_Treatment/better_prescribing_better_treatment.aspx?hkey=b6fb0ec0-8bc2-4e53-bf4c-9f148599cbeb&_zs=B3aFd1&_zl=KQ4o6">Better Prescribing, Better Treatment</a> initiative, will arrive in your inboxes next week. This feedback reporting program provides data compiled from the state's prescription monitoring program to physicians and other prescribing providers that allows them to see how their opioid prescribing practices compare to others in their health care system and specialty. </p> <p> There are two levels of reports: organizational and prescriber. The organization-level reports are sent quarterly to CMOs and QI leaders and summarize the prescribing practices in their organization by specialty. The prescriber-level reports are sent quarterly to each individual prescriber and summarize how an individual's prescribing practices compare to other prescribers in the same specialty and organization. </p> <p> For more information, please contact Monica Salgaonkar, WSMA's continuing professional development manager, at <a href="mailto:monica@wsma.org">monica@wsma.org</a>. </p> <h3>Developing tomorrow's leaders today</h3> <p> The WSMA <a href="[@]WSMA/Education/Physician_Leadership/Physician_Leadership_Course/WSMA/Physician_Leadership/Physician_Leadership_Course/Physician_Leadership_Course.aspx?hkey=30a53472-d3c0-4d7d-bd0c-cf09b4bea7f5&_zs=B3aFd1&_zl=LQ4o6">Physician Leadership Course</a> is a 40+ hour course for physicians and physician assistants who want to develop their health care leadership skills. Online virtual sessions will be held on Sept. 18-19 and Dec. 11, with eight weeks in between of self-guided online learning. The deadline to register is Aug. 18. </p> <p> Taking your leadership journey deeper, the WSMA <a href="[@]WSMA/Education/Physician_Leadership/Dyad_Leadership_Course/WSMA/Physician_Leadership/Dyad_Leadership_Course/Dyad_Leadership_Course.aspx?hkey=f6387317-48e4-44f1-b623-4b00fcba57ab&_zs=B3aFd1&_zl=MQ4o6">Dyad Leadership Course</a> is a 24+ hour educational workshop for physicians and their administrative dyad partners that helps improve team function and achieve greater operational success within their clinical system. Online virtual sessions will be held on Oct. 16-17 and Nov. 13, with four weeks in between of self-guided online learning. The deadline to register is Sept. 16. </p> <h3>Restarting health care in Washington state</h3> <p> Gov. Jay Inslee issued <a href="https://www.governor.wa.gov/sites/default/files/20-24.1%20-%20COVID-19%20Non-Urgent%20Medical%20Procedures%20Ext%20.pdf" target="_blank">a new proclamation regarding non-urgent procedures</a> this week that allows non-urgent health care services and surgeries to be provided once again. The proclamation emphasizes the importance of a health care provider's clinical judgment, stipulating that physicians and other providers should consider the needs of patients in the broader context of the pandemic, as well as adequate PPE, and urges providers to act with good judgment in delivering care. </p> <p> For more information on the criteria and how to comply with the proclamation, <a href="https://www.informz.net/WSMA/data/images/Attachments/Guidance-Document-Non-Urgent-Procedures-FINAL.pdf" target="_blank">download the WSMA's new guidance and physician practice checklist</a>. And be sure to check out WSMA's <a href="[@]WSMA/Resources/COVID-19/COVID-19_Clinical_Guidance_and_Testing/covid_19_clinical_guidance_and_testing.aspx?_zs=B3aFd1&_zl=NQ4o6">COVID-19 Resource</a> pages for more practice information to help assist you during the pandemic. </p> <p> With that, here's wishing you a restful Memorial Day weekend. As we reflect on the sacrifices of military heroes past and present, I know I'll also be thinking about the sacrifices of the medical heroes who are serving on the front lines of this pandemic. </p> </div>5/22/2020 12:00:00 AM1/1/0001 12:00:00 AM
governor_issues_new_proclamation_on_non_urgent_proceduresGovernor Issues New Proclamation on Non-Urgent ProceduresLatest_NewsShared_Content/News/Latest_News/2020/May/governor_issues_new_proclamation_on_non_urgent_procedures<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/MembershipMemo/2020/April/Surgery_room_645x425.jpg" class="pull-right" /> </div> <h5>May 18, 2020</h5> <h2>Governor Issues New Proclamation on Non-Urgent Procedures</h2> <p> This afternoon, Gov. Jay Inslee issued <a href="https://www.governor.wa.gov/sites/default/files/20-24.1%20-%20COVID-19%20Non-Urgent%20Medical%20Procedures%20Ext%20.pdf">a new proclamation regarding non-urgent procedures</a>. The proclamation allows for the performance of non-urgent health care services and surgeries provided that certain criteria and procedures are met. The proclamation also emphasizes the importance of a health care provider's clinical judgment, stipulating that physicians and other providers should consider the needs of patients in the broader context of the pandemic, and urging providers to act with good judgment in delivering care. </p> <p> The requisite procedures and criteria that must be in place before non-urgent health care services and surgeries may be performed include: <strong>1) care phase assessment; 2) criteria for resuming non-urgent procedures; and 3) considerations for practitioners resuming non-urgent procedures.</strong> </p> <h3>1) Care phase assessment</h3> <p> The proclamation requires "each health care, dental or dental specialty facility, practice or practitioner" to develop a care plan that reflects the COVID-19 risk assessment and the clinical/operational capabilities of the organization and responsive to the criteria below. Expansion/contraction of care plans should be based on standards of care that are in effect in the health care facility, practice, or practitioner's relevant geography as determined by that region's emergency health care coalition, as follows: </p> <ul> <li>Conventional care phase – All appropriate clinical care can be provided.</li> <li>Contingency care phase – All appropriate clinical care can be provided so long as there is sufficient access to personal protective equipment (PPE), and for hospitals, surge capacity is at least 20%.</li> <li>Crisis care phase – All emergent and urgent care shall be provided, <strong>including elective care that the postponement of which for more than 90 days would, in the judgement of the clinician, cause harm (see below for more on "harm"). The full suite of family planning services and procedures, newborn care, infant and pediatric vaccinations, and other preventive care, such as annual flu vaccinations, can continue.</strong></li> <ul> <li>"Harm" is evaluated the same as described in the May 7, 2020 <a href="https://www.governor.wa.gov/sites/default/files/Non-Emergent Procedure Interpretive Statement-Updated %28final%29.pdf" target="_blank">interpretive statement</a>.</li> </ul> </ul> <p> The new proclamation allows for a more regional approach to addressing the COVID-19 pandemic. It requires local health jurisdictions, in collaboration with local health partners, to assess the COVID-19 risk in their communities. <a href="https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020COVID19/DataDash">Information relevant to the county-level assessment is available here</a>. Contact your local health department or local health jurisdiction for more information. </p> <h3>2) Criteria for resuming non-urgent procedures</h3> <p> The updated proclamation also details criteria for resuming non-urgent procedures before there is a vaccine, effective treatment, or herd immunity to COVID-19. The provisions include monitoring resources (ventilators, beds, PPE, etc.), conserving PPE, and on-site fever screening and symptom screening for all patients, visitors, and staff—to name a few. A complete list of these provisions is available on pages four and five of <a href="https://www.governor.wa.gov/sites/default/files/20-24.1%20-%20COVID-19%20Non-Urgent%20Medical%20Procedures%20Ext%20.pdf">the proclamation</a>.<strong> </strong> </p> <h3>3) Considerations for practitioners resuming non-urgent procedures</h3> <p> <strong>The proclamation requires that practitioners must, in addition to the above, consider:</strong> </p> <ol> <li>The level and trending of COVID-19 infections in the relevant geography.</li> <li>The availability of appropriate PPE.</li> <li>Collaborative activities with relevant emergency preparedness and/or local health jurisdiction.</li> <li>Surge capacity of the hospital/care setting</li> <li>Availability of appropriate post-discharge options addressing transitions of care </li> </ol> <h3>Practice guidance on resuming elective procedures</h3> <p> The WSMA has collaborated with the Washington State Medical Group Management Association to offer new guidance on the proclamation for medical practices. <a href="javascript://[Uploaded files/Resources/COVID19/2020.05.29-Proclamation_Guidance_for_Medical_Practices.pdf]">Download this new resource</a>. If you have questions on this new WSMA resource or what the proclamation means for you and your practice, contact the WSMA policy department at <a href="mailto:policy@wsma.org">policy@wsma.org</a>. </p> </div>5/18/2020 12:00:00 AM1/1/0001 12:00:00 AM
new_webinar_opioids_and_telehealth_in_a_pandemicNew Webinar: Opioids and Telehealth in a PandemicLatest_NewsShared_Content/News/Membership_Memo/20200514/new_webinar_opioids_and_telehealth_in_a_pandemic<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/April/opioid_hydrocodone_bottle-645x425px.jpg" class="pull-right" alt="Hydrocodone bottle" /> </div> <h5>May 14, 2020</h5> <h2>New Webinar: Opioids and Telehealth in a Pandemic</h2> <p>Tune in today (Friday) from 1-2 p.m. for Opioids and Telehealth in a Pandemic, a virtual session for physicians and advanced practitioners caring for chronic pain patients via telemedicine during the pandemic. We will delve into: strategies to provide remote care for patients that you usually need to see in person, how to bill for telemedicine, regulatory changes to opioid prescribing and telemedicine policies, and the key features of the Better Prescribing, Better Treatment acute opioid reports. Speakers include Laura-Mae Baldwin, MD; Michael Parchman, MD, MPH; Jessica Schlicher, MD, MBA; Nathan Schlicher, MD, JD, MBA, FACEP; and WSMA Director of Policy Jeb Shepard. This activity has been approved for <em>AMA PRA Category 1 Creditâ„¢</em>. Register <a href="https://zoom.us/webinar/register/WN_txil7JdzRUibIRv_k4VEjw">online</a> and join us! For those unable to tune in, the session will be archived and offered on the WSMA website.</p> <h3>Other upcoming webinars</h3> <h4>Planning Tools to Meet the Unique Challenges of COVID-19</h4> <p>Part of Honoring Choices Pacific Northwest's series of free webinars on communication skills and tools in response to the COVID-19 pandemic. Featuring Stephanie Anderson, DNP, RN, executive director, Respecting Choices®.</p> <p>Friday, May 22, noon-1 p.m.</p> <p>Register <a href="https://register.gotowebinar.com/register/89394000289644302?source=HCPNW+Website">online</a>.</p> </div>5/14/2020 12:00:00 AM1/1/0001 12:00:00 AM
updates_on_telehealth_parity_practices_in_financial_crisisUpdates on Telehealth Parity, Practices in Financial CrisisLatest_NewsShared_Content/News/Membership_Memo/20200514/updates_on_telehealth_parity_practices_in_financial_crisis<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/May/telemed_smartphone_steth-645x425px.jpg" class="pull-right" alt="Stethoscope and smartphone" /> </div> <h5>May 14, 2020</h5> <h2>Updates on Telehealth Parity, Practices in Financial Crisis</h2> <p>Payment parity news, including action needed by lawmakers in Olympia on state parity measures, ERISA legislation introduced in Congress, and a breakthrough on Medicare telephone visits. Also, the WSMA announces new data showing physician practices experiencing worsening financial fallout from COVID-19.</p> <h3>Further action needed to extend telemedicine payment parity in Washington</h3> <p>In response to the outbreak, Gov. Jay Inslee issued a proclamation that immediately - and temporarily - implemented Senate Bill 5385, requiring that physicians be paid for telemedicine services at the same rate as if those services had been provided in person. On May 4, the governor extended the order through May 31, but further action is needed to keep telemedicine payment parity in place until the operative provisions of SB 5385 take effect (as per the original bill) on Jan. 1, 2021. If you haven't yet done so, <a href="https://takeaction.wsma.org/tell-lawmakers-to-put-patients-and-physicians-over-politics/">send a message to your state lawmakers</a> and urge their support for telehealth/phone consultation at payment parity with in-person visits through the end of the year, so that there is no gap in the law being in effect.</p> <p>At the federal level, the WSMA is supporting a new proposal from Rep. Kim Schrier (D-WA) that addresses another pain point frequently mentioned by physicians - reimbursement from self-insured ERISA plans for telemedicine services. HR 6644 would require ERISA plans to pay at parity with face-to-face services for care delivered via telemedicine. <a href="https://www.congress.gov/bill/116th-congress/house-bill/6644">Learn more about HR 6644</a>.</p> <h3>CMS broadens telehealth access and provides payment parity for telephone services</h3> <p>In our advocacy, the WSMA has also urged parity for another remote care delivery model: phone visits. Like telemedicine, telephone consults have become a vital strategy used by physicians to deliver patient care during the outbreak. In good news for physicians, the Centers for Medicare & Medicaid Services has recognized the need to better support audio-only telephone services by increasing payments for telephone visits to match payments for office and outpatient visits. CMS has increased payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020. CMS has cross-walked payment rates for CPT codes 99212, 99213, and 99214 to 99441, 99442, and 99443. CMS is also finalizing on an interim basis and for the duration of the COVID-19 public health emergency the following work RVUs: 0.48 for CPT code 99441; 0.97 for CPT code 99442; and 1.50 for CPT code 99443. You can read the rule <a href="https://www.cms.gov/files/document/covid-medicare-and-medicaid-ifc2.pdf" target="_blank">here</a> and the press release <a href="https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid">here</a>.</p> <p>CMS has also waived the interactive audio-video requirement for certain telehealth evaluation and management services, so now physicians can bill for these services when provided by audio-only telephone, provided all other applicable requirements are met. CMS has updated the list of eligible codes on the <a href="https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes">Medicare telehealth services list</a> and clearly marked which codes are eligible for audio-only. You can read the rule <a href="https://www.cms.gov/files/document/covid-medicare-and-medicaid-ifc2.pdf" target="_blank">here</a> and the press release <a href="https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid">here</a>.</p> <h3>Survey data show physician practices in financial crisis</h3> <p>Results from the WSMA's latest economic impact survey of physician clinics in Washington state illustrate the severe economic hardship many doctors' offices are facing as they struggle to remain available to patients in the community.</p> <p>Survey data, compiled in early May from 136 physician practices, represent a snapshot of what is happening in practices across the state and should serve as a wake-up call to both patients and policymakers as the state begins reintroducing health care services.</p> <p>On the financial impact on practices, survey respondents indicate, since March 1:</p> <ul> <li>On average, patient volume has decreased 62%.</li> <li>47% of practices have lost revenue up to $150,000. 32% have lost between $150,000 and $500,000. 13% have lost more than $1 million.</li> <li>73% of practices report only having 1-6 weeks "days cash on hand," defined as the number of days a practice could pay its operating expenses with cash available. Ideally, practices should have 18 weeks' worth.</li> </ul> <p>When asked what they expect if the status quo remains for the next 30 days, 30% of practices said they expect to lose an additional $100,000 to $250,000, 21% expect to lose between $250,000 and $1 million, and 11% expect to lose more than $1 million in revenue.</p> <p>As the survey indicates, practices are making decisions in response to financial constraints now. On the immediate impact on communities, survey respondents indicate, since March 1:</p> <ul> <li>67% are changing office hours</li> <li>55% are laying off or furloughing staff</li> <li>41% have stopped taking a paycheck</li> <li>21% have reduced physician salaries</li> <li>Nearly 20% have closed temporarily</li> </ul> <p>39% of survey respondents were solo practitioners. 40% were in practices of 2-10 physicians and 10% were in practices of 11-20 physicians. Less than 9% of respondents represented practices of 21-100 physicians, and less than 2% of respondents were from practices with over 100 physicians.</p> <p>As WSMA President William Hirota, MD, noted in <a href="[@]Shared_Content/News/Press_Release/2020/washingtons_physician_practices_in_financial_crisis_new_wsma_survey">a press release announcing the survey results</a>, "The WSMA is raising a clarion call on policymakers to act. Policymakers looked to the physician community to treat patients during the pandemic, and we did just that. The physician community is now looking to policymakers to help ensure that we can keep our doors open so we can continue that care."</p> </div>5/14/2020 12:00:00 AM1/1/0001 12:00:00 AM
washingtons_transition_to_telemedicine_during_covid_19_not_without_challengesWashington's Transition to Telemedicine During COVID-19 Not Without ChallengesLatest_NewsShared_Content/News/Press_Release/2020/washingtons_transition_to_telemedicine_during_covid_19_not_without_challenges<div class="col-md-12"> <div class="col-md-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>May 13, 2020</h5> <h2>Washington's Transition to Telemedicine During COVID-19 Not Without Challenges</h2> <p> SEATTLE - Health care's response to COVID-19 necessitated that many health care services be delivered via telemedicine, significantly accelerating the transition to remote delivery of health care. Two months into the pandemic in Washington, doctors and medical practices are relaying to the WSMA their success stories - and some significant struggles - as they ramp up or adopt telemedicine delivery models. </p> <p> Rodney Anderson, MD, president/CEO of Family Care Network, a network of local clinics located in Skagit and Whatcom counties, saw telemedicine visits go from about 1% in the beginning of March, to 60% only a month later. </p> <p> "We completed our 10,000th telemedicine visit in early April," said Dr. Anderson. </p> <p> In a recent WSMA statewide survey of physician practices, well over half were using telemedicine during the pandemic, and for those practices not using telemedicine, a clear majority were in the process of transitioning to using the technologies. The use of these remote care services was robust in those practices using them, with nearly a quarter using telemedicine for over half of their patient base. Approximately one out of ten practices using telemedicine indicated they used it exclusively when providing care. </p> <p> For practices not using telemedicine, when asked why, a third (33%) pointed to a lack of clarity around reimbursement and another third (34%) indicated they encountered barriers to adopting the technologies. In a follow-up survey, when asked what challenges practices were experiencing with adopting or utilizing telemedicine, common responses included: </p> <ul> <li>Technical/connectivity issues.</li> <li>Patients having inadequate internet access.</li> <li>Issues with patient age and experience with technology.</li> <li>Appointments via telemedicine taking more time than in-person visits.</li> <li>Struggles obtaining reimbursement from insurers.</li> </ul> <p> Seeing the benefit of telemedicine to physicians and patients, the WSMA has successfully advanced key telemedicine bills in the legislature over the last several years. To facilitate the transition to offering telemedicine services in response to the outbreak, Gov. Inslee issued a proclamation that immediately - and temporarily - implemented Senate Bill 5385, requiring that physicians be paid for telemedicine services at the same rate as if those services had been provided in person. On May 4, the governor extended the order through May 31, but further action is needed to keep telemedicine payment parity in place until the operative provisions of SB 5385 take effect (as per the original bill) on Jan. 1, 2021. </p> <p> As Washington state and the rest of the U.S. settle in for a protracted battle to slow the spread of the novel coronavirus SARS-CoV-2, the WSMA is urging both public and private health care policymakers to prioritize policy that facilitates the use of telemedicine technologies. </p> <p> At the federal level, the WSMA is supporting the proposal from Rep. Kim Schrier (D-WA) that addresses another pain point frequently mentioned by physicians - reimbursement from self-insured ERISA plans for telemedicine services. HR 6644 would require ERISA plans to pay at parity with face-to-face services for care delivered via telemedicine. </p> <p> The WSMA is also advocating for equal payment for another common remote technology - telephone visits. While not generally considered telemedicine, telephone visits are frequently used by physicians for some routine services, especially those delivered to the elderly, who may not have access to or prefer not to use a computer. Like telemedicine, telephone consults have become a vital strategy used by physicians to deliver patient care during the outbreak. </p> <p> Like virtually all of our state's businesses, physician practices have been financially impacted by the pandemic. Washington physicians report that patients have delayed or cancelled appointments or procedures for other medical conditions, with some care being delayed pursuant to state orders restricting non-urgent procedures. Telemedicine payment parity has been a life raft for many of our state's practices, helping to keep practices afloat and facilitating access to care for patients across the state. </p> <p> "The benefits of moving to telemedicine during an infectious disease outbreak like COVID-19 are well-understood: Patients can continue to see their physicians without the need to travel to a practice and risk exposure for the patient or the health care team," said William Hirota, MD, president of the Washington State Medical Association. "It's very important that everyone continue chronic care management and routine care without disruption or delay, to ensure that patients are being properly managed during this time of social distancing." </p> <p> <strong>For more information, contact:</strong> </p> <p> Cindy Sharpe<br /> 813.244.2883 (office/mobile)<br /> <a href="mailto:cindy@wsma.org">cindy@wsma.org</a> </p> <p> Graham Short<br /> 206.956.3633 (cell/text)<br /> <a href="mailto:gfs@wsma.org">gfs@wsma.org</a> </p> <p><strong>About the WSMA</strong></p> <p>The Washington State Medical Association represents more than 11,000 physicians, physician assistants, resident physicians and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care.</p> </div>5/13/2020 12:00:00 AM1/1/0001 12:00:00 AM
health_advisory_pediatric_multi_system_inflammatory_syndrome_potentially_associated_with_covid_19_inHealth Advisory: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19 iLatest_NewsShared_Content/News/Membership_Memo/20200514/health_advisory_pediatric_multi_system_inflammatory_syndrome_potentially_associated_with_covid_19_in<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/May/COVID-19-Response-645x425px.jpg" class="pull-right" alt="COVID-19 Response graphic" /> </div> <h5>May 12, 2020</h5> <h2>Health Advisory: Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19 in Children</h2> <p>The Washington State Department of Health issued the following health advisory today, May 12, 2020. The advisory asks physicians and other health care providers to report cases of "Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19."</p> <h3>Actions</h3> <ul> <li>Be aware that the novel coronavirus (COVID-19) has been recently reported as possibly linked with a pediatric multi-system inflammatory syndrome disease – "Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19."</li> <li>Consider "Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19" in children who present with persistent fever, inflammation (e.g., neutrophilia, elevated C-reactive protein and lymphopenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder). See below for additional information.</li> <li>Immediately reportcases of pediatric multi-system inflammatory syndrome potentially associated with COVID-19 in patients who are under 21 years of age to <a href="https://www.doh.wa.gov/AboutUs/PublicHealthSystem/LocalHealthJurisdictions">your local health jurisdiction</a>.</li> <li>Perform a PCR and serological testto detect the presence of SARS-COV-2, the virus that causes COVID-19, or corresponding antibodies in the patient.</li> <li>Use COVID-19 PPE and infection control precautions while patients are under evaluation for and if diagnosed with COVID-19.</li> </ul> <h3>Background</h3> <ul> <li>In the United Kingdom and Europe, a possible link has been reported between COVID-19 and a serious inflammatory disease recently termed "Pediatric Multi-System Inflammatory Syndrome Temporally Associated with COVID-19."</li> <li>As of May 11, 2020, one suspected pediatric clinical case compatible with multi-system inflammatory syndrome associated with COVID-19 has been reported in children in Washington state. As of May 5, 2020, 64 cases have been reported in children in New York state.</li> <li>This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash also may be present. Myocarditis and other cardiovascular changes may be seen. Additionally, some patients have developed cardiogenic or vasogenic shock and required intensive care. This inflammatory syndrome may occur days to weeks after acute COVID-19 illness.</li> <li>The syndrome may include:</li> <ul> <li>A child presenting with persistent fever, inflammation (e.g., neutrophilia, elevated C-reactive protein, ferritin, and lymphopenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder). This may include children meeting full or partial criteria for Kawasaki disease.</li> <li>Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, and infections associated with myocarditis such as enterovirus. Clinicians should not delay seeking expert advice while waiting for results of these investigations.</li> </ul> <li>Early recognition by pediatricians and prompt referral to an in-patient specialist, including to critical care is essential.</li> <li>This syndrome should be considered by pediatricians and specialists, particularly when other microbial etiologies have not been identified.</li> <li>Pediatricians and specialists should elicit any recent history of illness with COVID-19 or close contact with individuals who are known to have COVID-19 in children presenting with symptoms that are compatible with pediatric multi-system inflammatory syndrome potentially associated with COVID-19.</li> <li>The majority of patients who have presented with this syndrome have tested positive for SARS-CoV- 2 or corresponding antibodies. Some tested positive on diagnostic, molecular testing for SARS-CoV-2, others were positive on serological testing for corresponding antibodies.</li> </ul> <h4>RESOURCES</h4> <ul> <li><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31094-1/fulltext">Lancet correspondence (May 6, 2020)</a></li> <li><a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html">Centers for Disease Control and Prevention (CDC) COVID-19 Website</a></li> <li><a href="https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf" target="_blank">Royal College of Paediatrics and Child Health Guidance: Paediatric Multisystem Inflammatory Syndrome Temporally Associated with COVID-19</a></li> </ul> </div>5/12/2020 12:00:00 AM1/1/0001 12:00:00 AM
controlling_the_cost_of_careControlling the Cost of CareLatest_NewsShared_Content/News/Latest_News/2020/May/controlling_the_cost_of_care<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2020/COVER-WSMA_MayJune-2020-645x425px.jpg" class="pull-right" alt="WSMA Reports cover - May/June 2020" /></div> <h5>May 5, 2020</h5> <h2>Controlling the Cost of Care</h2> <p> By John Gallagher </p> <p> Companies are always looking for ways to trim costs, so it's no wonder that health care is often on the top of the list. Employer-sponsored health insurance covers about half of the non-elderly population in the United States, but at a significant cost. The Kaiser Family Foundation estimates that the average family insurance premium is more than $20,000 a year. On average, workers in 2019 paid $6,015 toward the cost of family coverage, with employers paying the rest. </p> <p> For years, some employers have tried to manage the financial burden by sharing more of it with their employees. Employee share of premium costs has risen more than 70% in the past 10 years. High-deductible plans were introduced on the grounds that workers with more skin in the game would be better health care consumers. (In fact, studies show the plans lead to a decrease in high-value care for patients.) </p> <p> The approach invariably created a backlash. "One of the reasons I think this has become more acute is the cost of a care episode has become more transparent with high-deductible plans," says David Grossman, MD, senior medical director for community health and external relations at Kaiser Permanente Washington. "The cost is hitting consumers in the face. High-deductible plans have unleashed a lot of concerns." </p> <p> Having failed to curtail their health care costs so far, employers are now looking to a new target to save money: physicians. According to a Jan. 13 article in Modern Healthcare, employers are "eyeing more aggressive measures to counter the formidable market power of consolidated hospitals and physician groups." </p> <p> The COVID-19 epidemic may only make that pressure worse. Faced with severe financial losses due to the economic downturn, companies will be increasingly desperate to squeeze every possible savings they can from their expenses. </p> <p> However, making cost the primary driver for decision-making about health care is short-sighted at best, even in light of the epidemic. While costs are driving the conversation, the real issue is the way the system is structured. Employers can help make the necessary changes in collaboration with physicians. </p> <p> "If you're talking about reducing the cost of care, you need comprehensive change," says Jennifer Hanscom, executive director and CEO of the WSMA. "It's not an easy fix. The concern about controlling costs, while important, could unfairly single out physicians and overlook other drivers of cost." </p> <h3>The search for solutions</h3> <p> Several public- and private-sector purchasers in Washington are pursuing innovative solutions that rely upon close collaboration with physicians. The Washington State Health Care Authority, which covers more than 2 million people through its Apple Health and state employee programs, has an ambitious goal: having 90% of health care it purchases be value-based, which rewards physicians and providers for the quality of care that they offer. State employees can choose from several value-based plans. </p> <p> Along with the HCA, Boeing has been a pioneer in this effort. In 2014, it contracted directly with UW Medicine and Providence Health & Services to offer a value-based plan for its employees. The HCA and Boeing plans promise not only lower costs for the employers, but a better patient experience for employees. </p> <p> Capitation can offer a way out of the fee-for-service cycle that can perversely reward overuse. "Payment mechanisms like capitation are the way to go for the future," says Dr. Grossman. </p> <p> Capitation is one way to solve the confusion inherent in the current payment system, agrees Philip Chan, MD, MHA, associate medical director for population health for UW Medicine/ Valley Medical Center. While the predominant fee-for-service system rewards physicians for the volume of care they provide, capitation rewards physicians for the quality of care they provide. </p> <p> However, few employers are as large as the HCA and Boeing. Smaller and mid-size companies lack the size to create similar plans. Their interest may be more in cost savings and less in innovation. As a result, employers may be tempted to use a much blunter approach to saving money by creating narrow networks and slashing physician payments. </p> <p> "We have to manage the problem of unintended consequences, such as the downside of narrow networks," says Hanscom. "Also, reducing reimbursements to physicians is a disincentive to participating in a plan, to say nothing of putting financial pressures on already struggling practices and contributing to physician burnout." </p> <h3>Targeting cost drivers</h3> <p> Considering physicians to be the problem and not the solution to health care costs overlooks a critical factor: Physicians know better where the waste is in the system and, as a result, where the savings lie. </p> <p> For example, a local company came to Confluence Health in North Central Washington seeking help to reduce the number of workers using emergency departments for regular primary care. As it turned out, the main reason why employees were turning to the ED for routine care was that they were afraid of missing work during regular business hours. </p> <p> Working with the company, Confluence set up a family practice clinic at the jobsite for employees and their dependents. The agreement provided Confluence with a bonus if it could reduce the company's total cost of care, while employees got incentives to improve their own health markers. As a result, ED visits declined by 25% and diabetic control measures improved by 40%. </p> <p> Confluence's example highlights one of the main drivers of cost: overuse. "When it comes to total health care costs, two factors have to be addressed: utilization and unit price," says Dr. Grossman. </p> <p> Simply ensuring clinical standards of care are followed more rigorously can lead to significant savings. "Utilization is the one thing we can tackle sooner than later," says Dr. Chan. "We have to try really hard to standardize our care and follow evidence-based clinical practice guidelines: If you're treating this, this should be your initial approach." </p> <p> As for unit price—the measure of how much it costs to deliver a particular treatment or service—the current system provides no incentive to measure or control it. </p> <p> "As a system, we don't understand what it costs to do things," says Edwin Carmack, MD, medical director for value-based care at Confluence Health. "We're the only business that doesn't know what it costs us to do something. We estimate based on what we get paid. What it costs us to do it, we don't know." A system in which physicians are responsible for the total cost of care would make that knowledge of unit cost essential and incentivize ways to control it. </p> <p> Plenty of cost drivers are available for employers to target. Spending on drugs is high on the list. </p> <p> "Having a tighter formulary can bring costs down a lot," says Dr. Grossman. "Ensure the right meds are going to the right people, not giving them too many drugs and expensive drugs unnecessarily." </p> <h3>Changing the system: a benefit for employers and physicians</h3> <p> As much as physicians are interested in employers moving toward a value- based system, they remain caught in a confusing world where fee-for-service is the primary system and demands are fragmented across different insurers. </p> <p> "It is challenging working with various versions of value-based contracts," Dr. Chan notes. "The requirements and number of quality metrics vary among payers. This results in labor-intensive data reporting and tracking. It makes it harder to home in and focus on clinically important metrics that providers can actually control." </p> <p> Ultimately, the question about how employers can cut costs should really be about how they can finally change the system for the better. Doing so will lead to the cost savings companies seek. </p> <p> In the meantime, physicians remain stuck in a system that is always pushing for change, but never quite does. </p> <p> "From the perspective of the physicians, they're still in two canoes: fee-for-service and value-based purchasing," says Hanscom. "For all the talk about innovation, we're not seeing enough of it." </p> <p> <em>John Gallagher is a Washington state- based freelance journalist who specializes in covering health care.</em></p> <p><em> This article was featured in the May/June 2020 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="[@]WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> </div>5/5/2020 12:00:00 AM1/1/0001 12:00:00 AM
hope_in_the_time_of_covid_19Hope in the Time of COVID-19Latest_NewsShared_Content/News/Latest_News/2020/May/hope_in_the_time_of_covid_19<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2020/COVER-WSMA_MayJune-2020-645x425px.jpg" class="pull-right" alt="WSMA Reports cover - May/June 2020" /></div> <h5>May 5, 2020</h5> <h2>Hope in the Time of COVID-19</h2> <p> "As a species, we have coexisted and survived with an immense assortment of organisms, all pushing for a niche in which they, too, can flourish. We turn out to be fantastically resourceful - both in our physical and in our social structures. Each challenge results in subtle changes to our systems. SARS-CoV-2 is just the latest of these challenges, and it, too, will require us to adapt in ways that are likely to strengthen our resilience even more. Humanity will get through this fine, but we need to be willing to make major changes in how we function and behave until either we're through the pandemic or we have mass immunization available. Our past successes give me great optimism about our future." - <em>John Bramhall, MD, PhD</em> </p> <p> "I am hopeful because I have seen teammates doing everything in their power to care for patients. Health care entities have collaborated in ways we would have never imagined - embracing technology to provide care in a matter of days instead of years. The way health care is delivered will be forever changed for the better. I am hopeful because I see compassionate people step forward to lend a helping hand. This crisis could have brought out the worst in us or the best in us - I am hopeful because it did the latter." - <em>Nariman Heshmati, MD</em> </p> <p> "What brings me hope is that each generation of Americans is challenged with fears and despair, but always comes through. Some call this American exceptionalism. I call it the American people. We will work together to defeat the enemy, and you can take that to the bank." - <em>William K. Hirota, MD</em> </p> <p> "Being at home with my daughter and seeing life through her eyes brings me hope. Being a doctor and mommy during these times is not easy. But looking to the future is what being a doctor mom is all about. Taking care of my patients, my work family, the residents I train, and my daughter is what brings me hope. Seeing us all come together... that brings me hope." - <em>Katina Rue, DO</em> </p> <p> "I am given hope by two responses that, together, give our society the strength to get through this: neighbors looking for ways to help each other even at risk to themselves, and organizations getting past corporate inertia to respond rapidly and appropriately to a crisis." - <em>Tom Schaaf, MD, MHA</em> </p> <p> "I find hope in my teammates in the emergency department where we see some of the darkest moments in people's lives. We provide compassion and hope to our patients, while caring for each other as a team. As we endure this season of COVID on the front lines, it is our ED family and those at home that help us through." - <em>Nathaniel Schlicher, MD, JD, MBA</em> </p> <p> "I'm impressed by the generosity of our patients who are obviously feeling poorly and suffering from chronic illness but are willing to forgo or delay treatment so that others who are more urgent can get the care they need. Stressful and life-changing events like this bring out the best in people. I see that in my patients. I also see hope in everyone pulling together and getting the job done. In this crisis, we've learned to keep nimble and not make simple things overly complicated." - <em>Mika Sinanan, MD, PhD</em> </p> <p><em> This article was featured in the May/June 2020 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="[@]WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> </div>5/5/2020 12:00:00 AM1/1/0001 12:00:00 AM
washingtons_physician_practices_in_financial_crisis_new_wsma_surveyWashington's Physician Practices in Financial Crisis: New WSMA SurveyLatest_NewsShared_Content/News/Press_Release/2020/washingtons_physician_practices_in_financial_crisis_new_wsma_survey<div class="col-md-12"> <div class="col-md-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>May 5, 2020</h5> <h2>Washington's Physician Practices in Financial Crisis: New WSMA Survey</h2> <p> SEATTLE - Results from a new survey* make clear the coronavirus pandemic is economically crippling physician practices in Washington, putting at risk the ability of patients to access care in communities across the state. </p> <p> The Washington State Medical Association recently conducted an economic impact survey of physician clinics in Washington state. The results from 136 physician practices illustrate the severe economic hardship many doctors' offices are facing as they struggle to remain available to patients in the community. </p> <p> The survey's results represent a devastating financial blow to community practices. More importantly, they represent an alarming threat to the ability of Washingtonians to access basic preventive, routine, and chronic health care services in their communities, as practices increasingly are compelled to cut back staff or services or even weigh their ability to stay open in response to the financial fallout of the COVID-19 crisis. </p> <p> The economic crisis is multifaceted. Practices are experiencing a significant drop in volume of in-patient visits due to state restrictions on non-urgent procedures while at the same time they are burdened with unexpected costs associated with the pandemic (these include outlays for telemedicine equipment and software, increased costs for personal protective equipment, and interest on loans to try to keep their practices afloat). Even more concerning, patient volumes are down as a result of fears around seeking care for health conditions during the COVID-19 crisis. </p> <p> "These new survey data are hugely concerning, both for the health of our patients and the health of our practices, as they go hand-in-hand," says William K. Hirota, MD, president of the WSMA. "This is the 'canary in the coal mine' of access to care for patients—if we don't act immediately to provide relief for these struggling practices, we will see downstream effects on the ability of our patients to access services in their communities." </p> <p> On the financial impact on practices, survey respondents indicate, since March 1: </p> <ul> <li>On average, patient volume has decreased 62%.</li> <li>47% of practices have lost revenue up to $150k. 32% have lost between $150k and $500k. 13% have lost more than $1 million.</li> <li>73% of practices report only having 1-6 weeks "days cash on hand," defined as the number of days a practice could pay its operating expenses with cash available. Ideally, practices should have 18 weeks' worth.</li> </ul> <p> When asked what they expect if the status quo remains for the next 30 days, 30% of practices said they expect to lose an additional $100k to $250k, 21% expect to lose between $250k and $1 million, and 11% expect to lose more than $1 million in revenue. </p> <p> As the survey indicates, practices are making decisions in response to financial constraints now. On the immediate impact on communities, survey respondents indicate, since March 1: </p> <ul> <li>67% are changing office hours</li> <li>55% are laying off or furloughing staff</li> <li>41% have stopped taking a paycheck</li> <li>21% have reduced physician salaries</li> <li>Nearly 20% have closed temporarily</li> </ul> <p> These data points represent a snapshot of what is happening in practices across the state and should serve as a wake-up call to both patients and policymakers. As the state begins reintroducing medical services, patients looking to book long overdue appointments may be in for a shock if practices have reduced hours or have closed as a result of the pandemic. And for our state policymakers, it's long understood that when patients are unable to access preventive, routine, or chronic primary care services in their community, they will delay care—leading to worsening health outcomes—or present in hospital emergency rooms, further stressing those critical care settings and raising costs for the health care system. </p> <p> Finally, the survey indicates the precariousness of the federal response in providing support for physician practices: </p> <ul> <li>Only roughly half of respondents (52%) who applied for a Paycheck Protection Program loan were successful in securing one.</li> <li>Most (53%) did not receive funds from the initial $30 billion tranche of Provider Relief funds.</li> <li>Overall, 58% of respondents said they were not able to source a continuous supply of PPE.</li> </ul> <p> "While we are moving forward with recovery plans, COVID-19 will remain in our communities, along with a host of other diseases and care needs. The WSMA is raising a clarion call on policymakers to act," says Dr. Hirota. "Policymakers looked to the physician community to treat patients during the pandemic, and we did just that. The physician community is now looking to policymakers to help ensure that we can keep our doors open so we can continue that care." </p> <p>Interview opportunities with some physicians who participated in this survey are available.</p> <p>*The latest WSMA Economic Impact Survey was sent on April 23 to 5,000 physicians working in independent (non-networked) physician clinics. Total respondents equaled 136.</p> <p> <strong>For more information, contact:</strong> </p> <p> Cindy Sharpe<br /> 813.244.2883 (office/mobile)<br /> <a href="mailto:cindy@wsma.org">cindy@wsma.org</a> </p> <p> Graham Short<br /> 206.956.3633 (cell/text)<br /> <a href="mailto:gfs@wsma.org">gfs@wsma.org</a> </p> <p><strong>About the WSMA</strong></p> <p>The Washington State Medical Association represents more than 11,000 physicians, physician assistants, resident physicians and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care.</p> </div>5/5/2020 12:00:00 AM1/1/0001 12:00:00 AM
what_are_we_spending_on_health_careWhat Are We Spending on Health Care?Latest_NewsShared_Content/News/Latest_News/2020/May/what_are_we_spending_on_health_care<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2020/COVER-WSMA_MayJune-2020-645x425px.jpg" class="pull-right" alt="WSMA Reports cover - May/June 2020" /></div> <h5>May 5, 2020</h5> <h2>What Are We Spending on Health Care?</h2> <p> By Pat Curry </p> <p> When Washington State Rep. Eileen Cody started her career as a nurse more than 40 years ago, "insurance wasn't that big of a deal," she said. "A lot of people didn't have insurance. You could go into a hospital without being insured." </p> <p> Today, with health care costs, insurance premiums, and out-of-pocket expenses higher than ever, some 400,000 Washingtonians are uninsured. For the tens of thousands more who buy insurance from the state's health benefit exchange, the out-of-pocket expenses are so high they can't afford to use it. It's insurance in name only. With the outbreak of COVID-19, access to high-quality, affordable health insurance is more important now than ever. </p> <p> Cody, who represents the 34th Legislative District (Vashon Island, West Seattle, White Center, and Burien), chairs the House Health Care and Wellness Committee. The most senior Democrat in the state House of Representatives, she has been a state legislator since 1994; with her decades of medical experience, Cody is a health policy leader in Washington state's legislature. </p> <p> WSMA Reports spoke with her about the recent legislative session and her vision for reducing health care costs in Washington state. The starting point for achieving that goal, Cody said, is getting a clear grasp of how much health care actually costs in the state. For that reason, she co-sponsored House Bill 2457 to establish a state health care cost transparency board. </p> <p> The purpose of the board is to calculate and analyze information and trends related to all health care costs in Washington. The board also must annually establish the health care cost growth benchmark for increases in total health expenditures and analyze provider and facility cost increases. At press time, the bill had passed both houses of the Legislature and was awaiting Gov. Jay Inslee's signature. </p> <p> "I'm trying to look at what we're really spending on health care across the state," Cody said. "It'd be nice to know what (health care) should cost. ... The CEO of a hospital said in front of our committee, 'Our billing has nothing to do with cost.' I've been saying that for 26 years! That's the problem." </p> <p> With a goal of reducing health care costs for the state's residents, the first thing Cody said she would like to do is to raise the Medicaid reimbursement rate and to lower reimbursement on other health plans, namely those for teachers and state employees. The health care cost transparency board will provide the data to make a case for that. </p> <p> The new panel, which will consist of public- and private-sector health insurance purchasers, will be responsible for annually calculating and releasing information on health care costs in Washington, including increases statewide for each health care provider, system, and payer. As in other states, the panel also will establish benchmarks for future health care cost increases and track expenditures against the annual benchmark. (The WSMA will nominate a physician to participate on an advisory committee that informs the panel's work.) </p> <p> "First we need to find out what we're spending and then look at how it's spent," Cody said. "We don't know what people are paying. If we can get [information on] the spend, then we can see where the cost drivers are." </p> <h3>Gaining insight from other states</h3> <p> Washington is not the first state to tackle total cost of care or implement a method of tracking health care expenses. Massachusetts, which enacted a health care cost containment law in 2012, is furthest along, Cody said. They established a new agency, the Massachusetts Health Policy Commission, to oversee health care system performance and provide policy recommendations regarding health care delivery and payment system reform. Its sister agency, the Center for Health Information and Analysis, collects health care information from payers, providers, provider organizations, and third-party administrators and is a primary source of health care analytics that support policy development. </p> <p> Cody said she doesn't want that kind of system for Washington state. </p> <p> "In Massachusetts, they have a whole commission and did a whole big hoopla," she said. "I didn't want another agency looking at health care costs." </p> <p> Data Washington state gets now from its all-payer claims database provide most pricing information but don't address total health care spending or the cost drivers behind the prices. </p> <p> "The question has been raised how much is regulation driving cost," Cody said. "That's a little down the road. First, let's find out what we're spending and then we can look at how it's spent." </p> <h3>The public option compromise</h3> <p> Looking back on the 2019 session, Cody readily admits that the state's public insurance option—the nation's first, which is set to go into effect next year— diverged from what she proposed in her initial bill. That was a plan that capped reimbursement at Medicare rates. In the bill that ultimately passed and was signed into law, the state-sponsored plan will cap reimbursement to providers and facilities at 160% of Medicare. </p> <p> "I always start out very aggressive knowing we'll have to compromise," she said. "The good thing is we have a standardized benefit package on the exchange. If nothing else happens, that's a good thing. It lowers the out-of-pocket expense and the deductible. That was outrageous; that's not really insurance." </p> <p> The state estimates the standardized benefit package, coupled with the reimbursement cap, could lower premiums by 5-10%. That's not a huge savings, but given the massive premium increases on the health benefit exchange plans (35% in 2018), any drop in the premium would be cause for celebration. (The WSMA participated in public option negotiations throughout the 2019 session. We opposed the final bill due to concerns that physicians and health care facilities would not be able to contract to participate in the plan under the terms envisioned in the law, resulting in health plans that don't have adequate access to care for enrollees.) </p> <p> The range of options being discussed at the state and national levels run from market-rate coverage to Medicare for All, "but there's no discussion about the rates," Cody said. "People still want choice, but they want everything for nothing and it just doesn't work too well that way. </p> <p> "I think it's great to have the total cost of care discussion to own up to how much does it cost for things," she said. </p> <p> Noting that prescription drug prices play a significant role in driving up health care costs, Cody noted that is one area that needs to be addressed at a federal level. It is ludicrous, she said, that the same drugs in other countries cost a fraction of the price than they do in the United States. </p> <p> "The U.S. does the research and everyone enjoys that benefit," she said. "We can't allow that to continue." </p> <p> State legislators passed a bill this session to cap the monthly out-of- pocket expense of insulin to $100 per month; at press time, that bill also was awaiting the governor's signature. Cody also favors legislation and/or regulation that would require insurers to apply prescription costs—and prescriptions bought using discount coupons—toward their customers' deductible and out-of- pocket expenses. </p> <p> "It's ridiculous they aren't counting the cost of drugs toward the deductible," she said. She noted that her former patients, who had multiple sclerosis, needed prescription drugs that cost $7,000-$8,000 a month. </p> <h3>Paying doctors the right amount</h3> <p> Asked whether recent and proposed tax increases on physicians and health care entities, such as the business and occupation tax, run counter to the push to make health care more affordable, Cody said she agreed that it "doesn't help, necessarily. That's designed to make sure we have the next generation of doctors through college and practicing." </p> <p> Given the opportunity to share what she wants Washington state doctors to know, Cody said, "We have to figure out how to get people paid the right amount of money for the work they do," she said. "It's wrong that doctors might get their bonuses from Press Ganey [patient satisfaction] scores. It tells them they can't say 'no' to a patient. That's not the way patient care should be measured. It should be patient outcomes. I appreciate a crusty doctor who does the right thing. </p> <p> "In my 40 years as a nurse and 26 years as a legislator, I have seen a lot of changes in health care," she said. "We still haven't made any headway on [addressing the cost]. There used to be an incentive to order tests; now, it's the other way around. I personally like more global budgeting, which increases payment if you do a good job. It's very hard to make those kinds of changes." </p> <p> <em>Pat Curry is senior editor of WSMA Reports.</em> </p> <p><em> This article was featured in the May/June 2020 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="[@]WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> </div>5/5/2020 12:00:00 AM1/1/0001 12:00:00 AM
weekly_rounds_may_1_2020_during_covid_19_advocacy_more_important_than_everWeekly Rounds: May 1, 2020 - During COVID-19, Advocacy More Important Than EverLatest_NewsShared_Content/News/Weekly_Rounds/2020/weekly_rounds_may_1_2020_during_covid_19_advocacy_more_important_than_ever<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="Weekly Rounds logo" class="pull-right" src="/images/Logos/Weekly-Rounds-Article-Graphic-645x425px.jpg" /></div> <h5>May 1, 2020</h5> <h2> During COVID-19, Advocacy More Important Than Ever </h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> We often describe what we do at the WSMA under the umbrella of one simple word: advocacy. With the onset of the COVID-19 crisis, I've found that to be true more than ever. Since early March, most of my time has been spent doing just that on behalf of our members. </p> <p> In doing that work, I've experienced that the meaning of advocacy is more than its Latin origins - "to call out for support" - though it is surely that. I happened across <a href="https://www.culturepartnership.eu/en/publishing/advocacy-course/what-is-advocacy">this quote</a>, which I think deftly describes our efforts during this pandemic: "To fulfill its aspirations advocacy requires coordination, strategic thinking, information, communication, outreach and mobilization." </p> <p> Each of those aspects is key to the work the WSMA has been doing. You can find out more about our specific efforts <a href="[@]WSMA/Resources/COVID-19/WSMA_Advocacy_for_Physicians_During_COVID_19/wsma_advocacy_for_physicians_during_covid_19.aspx">here</a> , and, in addition, I want to highlight a few activities here as well. </p> <p> We will soon shift to helping prepare our state to move into recovery mode by reopening our health system in total. We'll continue our work at the highest state levels with Gov. Jay Inslee, COVID-19 Health Systems Response Director Vice Adm. Raquel Bono, MD, Secretary of Health John Wiesman, and State Health Officer Kathy Lofy, MD. </p> <p> We will continue to advocate for a recovery plan that <a href="https://www.seattletimes.com/business/doctors-practices-are-hurt-by-coronavirus-pandemic-just-when-theyre-most-needed/?utm_source=facebook&utm_medium=social&utm_campaign=article_inset_1.1&fbclid=IwAR0uEI2kZ_dtFHqbmoIy3bKFwrQfEnPcOVcMjhv3J03fKcQfXaY8zvG0xJo">addresses the care of all of our patients</a>, <a href="https://www.heraldnet.com/news/how-will-it-end-testing-testing-testing-tracing-and-time/?fbclid=IwAR0r0H3JoDa-Vn0Upok8T9gAcwMgBt33gGw_jOXYzcd2C9QpQI3FWEhXZuE">the safety of our patients and health care workers</a>, and the <a href="https://stateofreform.com/news/washington/2020/04/wsma-ceo-jennifer-hanscom-discusses-the-financial-impact-of-covid-19/?fbclid=IwAR3x5RUTQwb0NJkQ98uuslr92qQ--5x3413qgHwlbY2rGDV2iCKIwWraSL0">viability of medical clinics</a> of all sizes and specialties. </p> <p> Currently, we are assessing the impact of COVID-19 on the financial state of practices, as well as the state of PPE and supplies. To that end, we have been gathering intel from our community on how the pandemic is impacting you. I hope you will take a moment to complete <a href="https://wsma.informz.net/informzdataservice/onlineversion/pub/bWFpbGluZ0luc3RhbmNlSWQ9OTI4ODk4NA==" target="_blank">our most recent survey</a>, as acquiring this data is critical to our advocacy work. While your anecdotal stories do help us humanize the issues, it's data that speaks most loudly to legislators. </p> <p> In other behind-the-scenes efforts, along with our partners, I've been working with the state's health leaders to advocate for clarity on the governor's proclamation regarding elective procedures, particularly around the proclamation's definition of "harm" and the intent of physicians using their medical judgment when determining whether a medically necessary procedure or surgery should be postponed. </p> <p> At the urging of the WSMA and others in the health care community, Gov. Inslee issued on Wednesday an <a href="https://www.governor.wa.gov/sites/default/files/Non-Emergent%20Procedure%20Interpretive%20Statement%204.29.20%20%28tmp%29.pdf?utm_medium=email&utm_source=govdelivery">interpretive statement</a> providing clarification on his <a href="https://www.governor.wa.gov/sites/default/files/proclamations/20-24%20COVID-19%20non-urgent%20medical%20procedures%20%28tmp%29.pdf" target="_blank">proclamation issued March 19</a> that imposed restrictions on "non-urgent" medical procedures. That document also outlines prerequisites for performing procedures and surgeries, such as maintaining appropriate PPE supplies and following <a href="https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/ConservationStrat-PPE.pdf" target="_blank">Department of Health guidance on the use of PPE</a>. </p> <p> As a reminder, the original March proclamation (still in effect) does not apply to outpatient clinics. As stated in the interpretive statement, "The proclamation permits outpatient clinic visits, both in hospital-based clinics and other outpatient clinic settings. While not addressed in the proclamation, the department encourages clinicians to weigh the benefits and risks of such visits to patients given the active presence of COVID-19 in our communities. It also encourages clinicians to use telehealth visits where possible." </p> <p> At the same time, WSMA's policy team swiftly worked to create a checklist to help practices adjust workflows and comply with the governor's proclamation. The checklist can be used manually or to build prompts into your electronic health record (e.g. Epic dot phrase). Find the checklist on our COVID-19 <a href="[@]WSMA/Resources/COVID-19_Response/COVID-19_Clinical_Guidance_and_Testing/WSMA/Resources/COVID-19/COVID-19_Clinical_Guidance_and_Testing/covid_19_clinical_guidance_and_testing.aspx?hkey=5236cdd9-90b5-46fe-9cbd-d9bf9ad4831e&_zs=B3aFd1&_zl=I97k6">Clinical and Professional Resources page</a>. </p> <p> During his press conference on Wednesday, Gov. Inslee also reviewed the <a href="https://coronavirus.wa.gov/what-you-need-know/covid-19-risk-assessment-dashboard">dashboard</a> he uses to help assess next steps on recovery. He uses five key statistical areas including: COVID-19 disease activity, the readiness of the health care system, the availability of testing, the capacity for contact tracing after people have been infected, and the risk to vulnerable populations. </p> <p> The governor also noted that he will announce more information about his plans for recovery today at 2:30 p.m. Watch the announcement at <a href="https://www.tvw.org">tvw.org</a>. </p> <p> Meanwhile, just as your work never ceases, neither does ours. We will continue our efforts, advocating for you and your concerns without ceasing. </p> </div>5/1/2020 12:00:00 AM1/1/0001 12:00:00 AM
governor_issues_new_guidance_on_non_urgent_proceduresGovernor Issues New Guidance on 'Non-Urgent' ProceduresLatest_NewsShared_Content/News/Membership_Memo/20200508/governor_issues_new_guidance_on_non_urgent_procedures<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/May/Surgery_room2_645x425.jpg" class="pull-right" alt="Surgery room" /> </div> <h5>April 30, 2020</h5> <h2> Governor Issues New Guidance on "Non-Urgent" Procedures </h2> <p> At the urging of the WSMA and others in the health care community, Gov. Jay Inslee issued an interpretive statement providing clarification on his <a href="https://www.governor.wa.gov/sites/default/files/20-24%20COVID-19%20non-urgent%20medical%20procedures%20%28tmp%29.pdf" target="_blank">proclamation</a> issued March 19 that imposed restrictions on "non-urgent" medical procedures. </p> <h3>What's in the interpretive statement</h3> <p> The interpretive statement clarifies the proclamation's definition of "harm" and the intent of physicians using their medical judgment when determining whether a medically necessary procedure or surgery should be postponed. The new interpretive statement also outlines prerequisites for performing procedures and surgeries, such as maintaining appropriate PPE supplies and following the Department of Health guidance on the use of PPE. Download the <a href="https://www.informz.net/WSMA/data/images/Attachments/Non-Emergent_Procedure_Interpretive_Statement_4.29.20.pdf" target="_blank">interpretive<strong> </strong>statement</a> released, April 29, 2020. </p> <p> <strong>As violating the March 19 proclamation could subject physicians to criminal penalties,the WSMA strongly urges you to review both the proclamation and interpretive statement.</strong> </p> <p> As a reminder, the March proclamation does not apply to outpatient clinics. As stated in today's interpretive statement, "The proclamation permits outpatient clinic visits, both in hospital-based clinics and other outpatient clinic settings. While not addressed in the proclamation, the department encourages clinicians to weigh the benefits and risks of such visits to patients given the active presence of COVID-19 in our communities. It also encourages clinicians to use telehealth visits where possible." </p> <h3>WSMA thanks governor, emphasizes liability concerns</h3> <p> The WSMA thanked the governor for releasing the clarifications of the original proclamation, which many physicians and hospitals found vague in intent. With criminal penalties attached to the original order, clinicians were cautious about proceeding with some medical procedures, largely focusing on those that would result in death or disability if postponed for three months. </p> <p> "Since the imposition of the order, we've heard numerous stories from physicians who describe situations where their patients with chronic health conditions are at home, in pain, and unable to schedule necessary procedures while their conditions worsen," said WSMA President William K. Hirota in a <a href="https://www.informz.net/WSMA/data/images/Attachments/Medical_Procedures_Proclamation_clarity_news_release-WORD_042820-FINAL-w-logo.pdf" target="_blank">statement</a>. "Patients need assurances that they can, and should, access necessary health care, and physicians need assurance their clinical decisions won't lead to criminal penalties." The WSMA is also seeking civil liability protections for physicians and other practitioners responding to the COVID-19 pandemic. <a href="http://wsma.informz.net/z/cjUucD9taT05MzAyMDMzJnA9MSZ1PTEwNzgxMDgzNjAmbGk9NzY0MDk3MTE/index.html">Learn more</a>. </p> <h3>New checklist to help you adjust practice workflow</h3> <p> To help your practice adjust its workflow and help comply with the governor's proclamation restricting non-urgent procedures, the WSMA offers a new checklist. Use the checklist manually or to build prompts into your electronic health record (e.g. Epic dot phrase). Download the checklist as a <a href="https://www.informz.net/WSMA/data/images/Attachments/Nonurgent_proc_dotphrase_04292020_WSMA.docx" target="_blank">Word document</a> or a <a href="https://www.informz.net/WSMA/data/images/Attachments/Nonurgent_proc_dotphrase_04292020_WSMA.pdf" target="_blank">PDF</a>. Please note that the checklist does not constitute legal advice.* </p> <p> By taking these precautions, physicians can make a difference in helping to preserve the limited PPE supply available to front-line health care personnel providing emergency and critical care in response to the pandemic, while keeping themselves, their patients, and their communities safe. </p> <p> <em>*This checklist is provided for general informational purposes only. It is not intended to provide or be relied upon for legal advice, and may not be comprehensive or ensure compliance with the requirements. Accordingly, before using this checklist, the WSMA strongly urges all physicians seeking to provide care during the pandemic to read the <a href="https://www.governor.wa.gov/sites/default/files/20-24%20COVID-19%20non-urgent%20medical%20procedures%20%28tmp%29.pdf" target="_blank">proclamation</a> and <a href="[@]doc_library/news/non_emergent_procedure_interpretive_statement_42920.pdf" target="_blank">interpretive statement</a> to understand requirements in detail.</em> </p> </div>4/30/2020 12:00:00 AM1/1/0001 12:00:00 AM
pmp_ehr_integration_mandate_delayed_until_september_2021PMP-EHR Integration Mandate Delayed Until September 2021Latest_NewsShared_Content/News/Membership_Memo/20200508/pmp_ehr_integration_mandate_delayed_until_september_2021<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/May/Rx_bottle_doctor_laptop_645x425.jpg" class="pull-right" alt="Doctor with prescription medicine bottle" /> </div> <h5>April 29, 2020</h5> <h2>PMP-EHR Integration Mandate Delayed Until September 2021</h2> <p> <a href="https://app.leg.wa.gov/billsummary?BillNumber=5380&Year=2019&Initiative=false">Senate Bill 5380</a>, a measure aimed at addressing the opioid epidemic, was signed into law during the 2019 legislative session. Among other provisions, the bill requires electronic health record integration with the state's prescription monitoring program for practices with 10 or more prescribers beginning on Jan. 1, 2021. Last week, in response to protracted WSMA advocacy on the issue, Secretary of Health John Wiesman announced he'd be delaying the EHR-PMP integration requirement due to the COVID-19 public health emergency and its impact on the financial viability of physician practices. Practices will now be required to complete integration by September 30, 2021. </p> <p> For practices with 10 or more prescribers facing additional hurdles to integration, SB 5380 does allow for an economic/technical hardship or exceptional circumstance exemption to the mandate. The WSMA has been working with DOH staff as they draft and finalize the details of the waiver process. We will continue to advocate for flexibility for physicians and their practices moving forward. Should you have questions on the EHR-PMP integration requirement, please don't hesitate to contact the WSMA policy department at <a href="mailto:policy@wsma.org">policy@wsma.org</a>. </p> </div>4/29/2020 12:00:00 AM1/1/0001 12:00:00 AM
take_action_today_tell_lawmakers_to_put_patients_and_physicians_over_politicsTake Action Today: Tell Lawmakers to Put Patients and Physicians Over PoliticsLatest_NewsShared_Content/News/Membership_Memo/20200424/take_action_today_tell_lawmakers_to_put_patients_and_physicians_over_politics<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Logos/Megaphone-Evergreen-645x425px.jpg" class="pull-right" /> </div> <h5>April 29, 2020</h5> <h2>Take Action Today: Tell Lawmakers to Put Patients and Physicians Over Politics</h2> <p> So much about health care has changed in the past few weeks, from the way patients access care to your practices' business model and everything in between. But the one thing that has remained the same is that you're there for your patients every day, providing care and prioritizing their health above your own. You deserve to know that lawmakers in Olympia are working to support the physician community just as you're working to support your patients. </p> <p> Currently pending in Olympia are three policies that are desperately needed to help ensure patient access to care in Washington. Lawmakers need to hear from you today in support of: </p> <ul> <li><strong>Providing clarity on Gov. Jay Inslee's nonurgent procedure delay order</strong>, so that physicians know the circumstances under which they can provide needed care.</li> <li><strong>Enacting liability protections for front-line health care practitioners</strong>, giving certainty to physicians that they won't be punished for treating patients during the pandemic.</li> <li><strong>Continuing to reimburse telemedicine at parity with in-person visits</strong>, to support the transition to remote care.</li> </ul> <p> These three policies are in jeopardy—not because of their merits, but because of politics. </p> <p> We know there are powerful interest groups in Olympia. And we understand that people are frustrated with the constraints of the "stay home, stay healthy" order. But we can't let politics take priority over science and over patients being able access the care that they need. </p> <p> Our state's physician community has been steadfast in prioritizing public health over politics and over their own business interests. We supported social distancing restrictions to keep people healthy. We advocated for delaying nonurgent medical procedures to preserve personal protective equipment. And we continue to show up to work every day to treat the patients who need care. </p> <p> <strong>It's time that Olympia shows physicians the same support we've shown our patients. </strong> </p> <p> Our state lawmakers must take action on these issues now. Learn more and send a message to the governor's office and your state legislators today. </p> <a href="https://takeaction.wsma.org/tell-lawmakers-to-put-patients-and-physicians-over-politics/" class="TextButton">Take Action</a> </div>4/29/2020 12:00:00 AM1/1/0001 12:00:00 AM
wsma_thanks_governor_for_clarity_on_providing_medically_necessary_careWSMA Thanks Governor for Clarity on Providing Medically Necessary CareLatest_NewsShared_Content/News/Press_Release/2020/wsma_thanks_governor_for_clarity_on_providing_medically_necessary_care<div class="col-md-12"> <div class="col-md-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>April 29, 2020</h5> <h2>WSMA Thanks Governor for Clarity on Providing Medically Necessary Care </h2> <p> SEATTLE - Acting at the urging of many in the medical and hospital community, Gov. Jay Inslee today issued an interpretive statement providing clarification on his <a href="https://www.governor.wa.gov/sites/default/files/20-24%2520COVID-19%2520non-urgent%2520medical%2520procedures%2520%2528tmp%2529.pdf?utm_medium=email&utm_source=govdelivery" target="_blank">March 19 proclamation</a> that imposed restrictions on "non-urgent" medical procedures. This interpretive statement clarifies the initial proclamation's definition of "harm" and the intent of physicians using their medical judgment when determining whether a medically necessary procedure or surgery should be postponed. </p> <p> Many physicians and hospitals found the original proclamation vague in its intent. With criminal penalties attached to the original order, clinicians were cautious about proceeding with some medical procedures, largely focusing on those that would result in death or disability if postponed for three months. </p> <p> "Since the imposition of the order, we've heard numerous stories from physicians who describe situations where their patients with chronic health conditions are at home, in pain, and unable to schedule necessary procedures while their conditions worsen," said William K. Hirota, MD, president of the Washington State Medical Association. "Patients need assurances that they can, and should, access necessary health care, and physicians need assurance their clinical decisions won't lead to criminal penalties." </p> <p> Some of the issues clarified in the <a href="https://www.informz.net/WSMA/data/images/Attachments/Non-Emergent_Procedure_Interpretive_Statement_4.29.20.pdf" target="_blank">newly released interpretive statement</a> include what constitutes "harm" when determining which procedures can safely be delayed for three months pursuant to the order. Furthermore, the statement emphasizes clinicians should use clinical judgment when determining whether to perform procedures considered to be non-urgent or elective. </p> <p> The interpretive statement notes: "To clarify, the department leaves assessment of harm up to the individual clinician. In order to assess harm, clinicians should consider if a patient's illness or injury is causing significant pain, significant dysfunction in their daily life or work, or is either progressing, or at risk to progress." </p> <p> The interpretive statement also outlines prerequisites for performing procedures and surgeries, such as maintaining appropriate personal protective equipment (PPE) supplies and following the Department of Health guidance on the use of PPE. </p> <p> "We appreciate the ongoing focus to ensure adequate PPE at our state's hospitals. As physicians and medical leaders, we fully recognize the importance of ensuring that we have proper PPE to protect both our workforce and our patients," Hirota said. "It's a delicate dance. It's vitally important to continue to have capacity and supplies in our system to treat COVID-19 patients, while also providing other necessary care to ensure our patients are maintaining their health and well-being." </p> <p> The WSMA will continue to work with the governor, COVID-19 Health Systems Response Director V. Admiral Bono, MD, Secretary of Health John Wiesman and State Health Officer Kathy Lofy, MD, in preparing our state to move into recovery mode by reopening our health system in total. </p> <p><strong>For media inquiries, contact:</strong></p> <p> Graham Short<br /> WSMA Communications<br /> 206.956.3633 or <a href="mailto:gfs@wsma.org">gfs@wsma.org</a></p> <p> <strong>About the Washington State Medical Association </strong><br /> The Washington State Medical Association represents more than 11,000 physicians, physician assistants, resident physicians and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine for more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care. </p> <p> <strong>About the Washington Chapter of the American Academy of Pediatrics</strong><br /> The Washington Chapter of the American Academy of Pediatrics has advocated for the health and well-being of Washington's children and their families since 1934. The WCAAP represents over 1100 pediatric health care providers from across Washington State. Our mission is to optimize the health and well-being of children and their families while advancing pediatric care. WCAAP frames and leads the public discussion on child health issues, advances public policy to benefit children, and empowers pediatricians to provide quality medical care. </p> </div>4/29/2020 12:00:00 AM1/1/0001 12:00:00 AM
the_wsma_calls_on_governor_to_clarify_where_and_when_care_may_be_deliveredThe WSMA Calls on Governor to Clarify Where and When Care May Be DeliveredLatest_NewsShared_Content/News/Press_Release/2020/the_wsma_calls_on_governor_to_clarify_where_and_when_care_may_be_delivered<div class="col-md-12"> <div class="col-md-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>April 28, 2020</h5> <h2>The WSMA Calls on Governor to Clarify Where and When Care May Be Delivered</h2> <p> SEATTLE - Acting at the urging of many in the medical community, including the Washington State Medical Association, Gov. Jay Inslee issued <a href="https://www.governor.wa.gov/sites/default/files/proclamations/20-24%252520COVID-19%252520non-urgent%252520medical%252520procedures%252520%252528tmp%252529.pdf">Proclamation 20-24</a> on March 19, imposing restrictions on "non-urgent" medical procedures. The WSMA today is urging Gov. Inslee to clarify the application of his nonurgent procedure delay order so that physicians have clear direction on the conditions under which patient care may be delivered. </p> <p> Acting out of the abundance of caution, many physicians have necessarily opted to postpone surgeries to comply with the order and conserve resources, especially personal protective equipment (PPE). In other cases, patients have postponed routine care out of uncertainty about what care can be received, as well as whether it's safe to go to the clinic. </p> <p> "Since the imposition of the order, we've heard numerous stories from physicians who describe situations where their patients with chronic health conditions are at home, in pain, and unable to schedule necessary procedures while their conditions worsen," said William K. Hirota, MD, president of the WSMA. "Patients need assurances that they can, and should, access necessary health care, and physicians need assurance their clinical decisions won't lead to criminal penalties." </p> <p> Some of the issues needing clarification include defining what constitutes "harm" in determining which procedures can safely be delayed for three months pursuant to the order. Furthermore, clinicians should be able to use clinical judgment to determine performance of procedures considered to be non-urgent or "elective." </p> <p> In addition to asking for clarification of the elective procedures proclamation, the WSMA submitted a proposal to the governor and the legislature that asks for assurance that physicians won't be held civilly liable for exercising their clinical judgment when providing needed care during the pandemic. The WSMA's proposal would provide health care professionals immunity from civil liability for any adverse outcome alleged to have been sustained because of any acts or omissions undertaken in good faith while providing health care services during emergencies, such as this COVID-19 pandemic. The proposal would extend the same liability protections that are currently afforded to <a href="https://app.leg.wa.gov/RCW/default.aspx?cite=70.15">emergency volunteer health practitioners</a> while an emergency declaration is in effect to physicians and other providers in our state who are responding to the pandemic. </p> <p> Several states have already taken steps to address this threat, including New York, Wisconsin and Massachusetts. "There are criminal penalties for treating a patient outside of compliance with the order. And there is potential civil liability for delivering care during the pandemic, as well as for delaying care where it results in adverse health outcomes. That's why it's so important that physicians get clarity on delay order, as well as liability protections for how care is having to be delivered during the pandemic," Dr. Hirota said. "Physicians need to be able to proceed with certainty and without fear of retribution, so that patients can get the care they need." </p> <p> Dr. Hirota continued, "It's deeply troubling to think that patients are not receiving care they need because they fear accessing needed treatment or because physicians, acting out of an abundance of caution, are applying too strict of an interpretation on the governor's proclamation limiting elective or non-urgent procedures. The health care community needs clarity now, so that physicians can operate with certainty, and patients can get the care they need." </p> <p> For more information, contact: </p> <p> Cindy Sharpe<br /> 813.244.2883 (office/mobile)<br /> <a href="mailto:cindy@wsma.org">cindy@wsma.org</a> </p> <p> Graham Short<br /> 206.956.3633 (cell/text)<br /> <a href="mailto:gfs@wsma.org">gfs@wsma.org</a> </p> <p><strong>About the WSMA</strong></p> <p>The Washington State Medical Association represents more than 11,000 physicians, physician assistants, resident physicians and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care.</p> </div>4/28/2020 12:00:00 AM1/1/0001 12:00:00 AM
updates_on_new_ppp_funding_additional_hhs_provider_relief_funds_and_moreUpdates on New PPP Funding, Additional HHS Provider Relief Funds, and MoreLatest_NewsShared_Content/News/Membership_Memo/20200424/updates_on_new_ppp_funding_additional_hhs_provider_relief_funds_and_more<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/April/COVID-19-financial-relief-645x425px.jpg" class="pull-right" alt="COVID-19 Financial Relief logo" /> </div> <h5>April 24, 2020</h5> <h2>Updates on New PPP Funding, Additional HHS Provider Relief Funds, and More</h2> <p> Here's the latest on federal movement on a new stimulus package, new direct deposit funds starting this week, and several updates on financial assistance measures underway. </p> <h3>Congress passes The Paycheck Protection Program and Health Care Enhancement Act</h3> <p> The U.S. Senate and House of Representatives passed a new stimulus package, which aims to replenish the funds for the small business loan program. The Trump administration has promised a quick signature once on the president's desk. </p> <p> Highlights of the Act include: </p> <ul> <li>$321 billion in new funding for the Paycheck Protection Program.</li> <li>$75 billion for reimbursement to hospitals and health care providers to support the need for COVID-19-related expenses and lost revenue. This funding is in addition to the $100 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act.</li> <li>$25 billion for necessary expenses to research, develop, validate, manufacture, purchase, administer, and expand capacity for COVID-19 tests. Specific funding is provided for:</li> <ul> <li>$11 billion for states, localities, territories, and tribes to develop, purchase, administer, process, and analyze COVID-19 tests, scale-up laboratory capacity, trace contacts, and support employer testing. Funds are also made available to employers for testing.</li> <ul> <li>$2 billion provided to States consistent with the Public Health Emergency Preparedness grant formula, ensuring every state receives funding.</li> <li>$4.25 billion provided to areas based on relative number of COVID-19 cases.</li> <li>$750 million provided to tribes, tribal organizations, and urban Indian health organizations in coordination with Indian Health Service.</li> </ul> </ul> </ul> <p>The AMA provides a <a href="javascript://[Uploaded files/News and Publications/Newsletters/2020/Paycheck Protection Program and Health Care Enhancement Act Summary (4-23-20).pdf]">detailed summary of the legislation</a>.</p> <p> ICYMI: The WSMA offers an archived webinar, featuring attorneys from K&L Gates, which provides guidance on how to tap into federal financial assistance programs. Visit the WSMA website to <a href="[@]WSMA/Resources/COVID-19_Response/Financial_Viability_During_COVID-19/WSMA/Resources/COVID-19/Financial_Viability_During_COVID-19/financial_viability_during_covid_19.aspx?hkey=59bdde18-196d-479e-bfab-10b7ddd7b227">view the webinar</a>. </p> <h3>New HHS provider relief funds released this week</h3> <p> The U.S. Department of Health & Human Services announced more funds from the $100 billion CARES Act Provider Relief Fund will be released starting this week. In good news for physicians, this new dispersion takes into consideration practices that were disadvantaged by the previous payment methodology. Here's what you need to know—and note that some practices that do not see many Medicare patients will need to be proactive. From the HHS press release: </p> <ul> <li><em>HHS has indicated funds will be going out quickly to help providers with a relatively small share of their revenue coming from Medicare fee-for-service, such as children's hospitals.</em> </li> <li><em>Those funds are beginning to be delivered this week. HHS will begin distribution of the remaining $20 billion of the general distribution to these providers to augment their allocation so that the whole $50 billion general distribution is allocated proportional to providers' share of 2018 net patient revenue.</em> </li> <li><em>On April 24, a portion of providers will automatically be sent an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file will need to submit their revenue information to the <a href="https://www.hhs.gov/provider-relief/index.html">CARES Act Provider Relief Fund Payment Attestation Portal</a> opening this week for additional general distribution funds.</em> </li> <li><em>Providers who receive their money automatically will still need to submit their revenue information so that it can be verified.</em> </li> <li><em>Payments will go out weekly, on a rolling basis, as information is validated, with the first wave being delivered at the end of this week (April 24, 2020).</em></li> </ul> <p>Read the <a href="https://www.hhs.gov/about/news/2020/04/22/hhs-announces-additional-allocations-of-cares-act-provider-relief-fund.html">HHS announcement for details</a>.</p> <p> A reminder: Physicians who have been allocated a payment from the Provider Relief Fund general distribution must sign an attestation confirming receipt of the funds and agree to the terms and conditions within 30 days of payment. The terms and conditions are <a href="https://www.hhs.gov/sites/default/files/relief-fund-payment-terms-and-conditions.pdf" target="_blank">listed here</a>. Access the attestation portal <a href="https://covid19.linkhealth.com/#/step/1">here</a>. </p> <p> Physicians should note that, as a condition of receiving the HHS funds, balance billing is prohibited. From the press release: </p> <p> <em>President Trump is committed to ending surprise bills for patients. As part of this commitment, as a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a presumptive or actual COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.</em> </p> <h3>Medicare 2% payment increase to take effect on May 1</h3> <p> The CARES Act temporarily suspends the -2% sequestration payment adjustment on Medicare fee-for-service payment. This means that physicians will see a 2% payment increase on Medicare claims effective May 1, 2020. The increase is effective for claims with dates of service from May 1, 2020, through December 31, 2020. </p> <p> Since the passage of Sequestration Transparency Act of 2012, Medicare payments have been subject to a 2% sequestration reduction. These cuts are the result of a congressional deal to address the debt ceiling crisis. </p> </div>4/24/2020 12:00:00 AM1/1/0001 12:00:00 AM
wsma_works_with_state_to_outline_resumption_of_serviceWSMA Works with State to Outline Resumption of ServiceLatest_NewsShared_Content/News/Membership_Memo/20200424/wsma_works_with_state_to_outline_resumption_of_service<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2020/April/Surgery_room_645x425.jpg" class="pull-right" alt="Surgery room" /> </div> <h5>April 24, 2020</h5> <h2>WSMA Works with State to Outline Resumption of Service</h2> <p> With Washington state having "flattened the curve" and no longer projecting an overwhelmed health care system, the WSMA is working with state and health care leaders to develop guidance on resuming services. </p> <h3>Confusion persists on governor's proclamation on elective surgeries and procedures</h3> <p>Due to ongoing confusion about what can and can't be done in the hospital and ambulatory surgical communities with regards to "elective" surgeries or "nonurgent procedures," the WSMA, the Washington State Hospital Association, the Washington Ambulatory Surgery Center Association, and others requested an interpretive statement from Gov. Jay Inslee and the state Department of Health on the order, specifically looking for more clarity on the definition of harm. </p> <p> As we await action on the statement, we want to emphasize the <a href="https://www.governor.wa.gov/sites/default/files/20-24 COVID-19 non-urgent medical procedures %28tmp%29.pdf?utm_medium=email&utm_source=govdelivery">governor's proclamation</a> applies to hospitals, ambulatory surgery facilities, dental, orthodontic, and endodontic offices in Washington—not outpatient clinics. The proclamation allows performance of all services considered to be "emergent" or "urgent" for which delay would result in worsening a life-threatening or debilitating prognosis. Specific language in the proclamation reads: "Hospitals and ambulatory surgical facilities may perform any surgery that if delayed or canceled would result in the patient's condition worsening." Clinicians should use clinical judgment to determine the best course of care for their patients. </p> <h3>More physicians and facilities report patients delaying care </h3> <p> More physicians are reporting a troubling trend of patients who are avoiding seeking needed care, possibly due to various factors: a reluctance to go into perceived "dangerous" health care settings, confusion about state prohibitions on elective and nonurgent procedures, or statewide stay-at-home orders. </p> <p> Since the WSMA first reported on the issue in <a href="[@]Shared_Content/News/Weekly_Rounds/2020/weekly_rounds_april_17_2020_advocacy_and_answers_in_the_time_of_covid_19">last week's Weekly Rounds</a>, which included a look at concerns from within the <a href="https://www.knkx.org/post/washington-state-doctors-puzzled-drop-heart-attack-stroke-patients-amid-covid-19">UW Medicine system</a>, we've gathered the following local data points: </p> <ul> <li>Bellevue Overlake Medical Center's stroke program notes reductions from March through April in code stroke activations (51%), Alteplase administration (62%), and mechanical thrombectomy (38%) compared with the same time last year.</li> <li>The Washington State Department of Health reports that visits to emergency departments in Washington are down nearly 40% compared to last year.</li> <li>A <a href="https://www.propublica.org/article/theres-been-a-spike-in-people-dying-at-home-in-several-cities-that-suggests-coronavirus-deaths-are-higher-than-reported">ProPublica article</a> noted that data in Seattle indicates that EMT and paramedic calls dropped by more than 25% in the first 10 days of April compared with the same time frame last year.</li> </ul> <p> The "Stay Home, Stay Healthy" mandate does not apply when a patient is sick or needs care. In those instances, "you may need to leave home in order to stay healthy," as WSMA President Bill Hirota, MD, says in a <a href="https://vimeo.com/410792380">new public service announcement</a> released this week. That PSA, plus a second PSA urging patients to seek care for stroke symptoms, are available on the WSMA's <a href="[@]WSMA/Resources/COVID-19_Response/COVID-19_Patient_Education/WSMA/Resources/COVID-19/COVID-19_Patient_Education/covid_19_patient_education.aspx?hkey=1883b646-8a34-48dc-926d-c9711850a7cd#psa">website</a> and social channels. </p> </div>4/24/2020 12:00:00 AM1/1/0001 12:00:00 AM
 

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